Alharthy Nesrin, Al Queflie Sulaiman, Alyousef Khalid, Yunus Faisel
Department of Emergency Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
Department of Pediatrics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
J Emerg Trauma Shock. 2015 Apr-Jun;8(2):88-93. doi: 10.4103/0974-2700.155504.
Computed tomography (CT) used in pediatric pediatrics brain injury (TBI) to ascertain neurological manifestations. Nevertheless, this practice is associated with adverse effects. Reports in the literature suggest incidents of morbidity and mortality in children due to exposure to radiation. Hence, it is found imperative to search for a reliable alternative.
The aim of this study is to find a reliable clinical alternative to detect an intracranial injury without resorting to the CT.
Retrospective cross-sectional study was undertaken in patients (1-14 years) with blunt head injury and having a Glasgow Coma Scale (GCS) of 13-15 who had CT performed on them. Using statistical analysis, the correlation between clinical examination and positive CT manifestation is analyzed for different age-groups and various mechanisms of injury.
No statistically significant association between parameteres such as Loss of Consciousness, 'fall' as mechanism of injury, motor vehicle accidents (MVA), more than two discrete episodes of vomiting and the CT finding of intracranial injury could be noted. Analyzed data have led to believe that GCS of 13 at presentation is the only important clinical predictor of intracranial injury.
Retrospective data, small sample size and limited number of factors for assessing clinical manifestation might present constraints on the predictive rule that was derived from this review. Such limitations notwithstanding, the decision to determine which patients should undergo neuroimaging is encouraged to be based on clinical judgments. Further analysis with higher sample sizes may be required to authenticate and validate findings.
计算机断层扫描（CT）用于儿科脑损伤（TBI）以确定神经学表现。然而，这种做法会带来不良反应。文献报道显示儿童因辐射暴露出现发病和死亡事件。因此，寻找可靠的替代方法势在必行。
本研究的目的是找到一种可靠的临床替代方法，无需借助CT就能检测颅内损伤。
对1至14岁钝性头部损伤且格拉斯哥昏迷量表（GCS）评分为13 - 15分并接受CT检查的患者进行回顾性横断面研究。运用统计分析，针对不同年龄组和各种损伤机制，分析临床检查与CT阳性表现之间的相关性。
未发现意识丧失、“跌倒”作为损伤机制、机动车事故（MVA）、超过两次离散性呕吐发作等参数与颅内损伤的CT表现之间存在统计学显著关联。分析数据表明，就诊时GCS评分为13分是颅内损伤唯一重要的临床预测指标。
回顾性数据、小样本量以及评估临床表现的因素数量有限，可能会对本综述得出的预测规则构成限制。尽管存在这些局限性，但仍鼓励根据临床判断来决定哪些患者应接受神经影像学检查。可能需要更大样本量的进一步分析来验证和确认研究结果。
